The Alabama Medicaid Agency's Program
Integrity Division is responsible for planning,
developing and directing Agency efforts to
identify, prevent and prosecute fraud, abuse
and/or misuse in the Medicaid program. This
includes verifying that medical services are
appropriate and rendered as billed, that
services are provided by qualified providers to
eligible recipients, that payments for those
services are correct and that all funds
identified for collection are pursued.
The purpose of the division is:
- To guard against fraud, abuse and deliberate misuse of
Medicaid program benefits by individual providers and
recipients;
- To ensure that Medicaid recipients receive necessary medical
care at a level of quality consistent with that available to the
general population;
- To assure provider and recipient compliance with federal and
state Medicaid rules and regulations;
- To assist in the identification of claims processing
procedures that may be in conflict with State policy.